The hallmark symptoms of multiple sclerosis are unpredictable periods of exacerbation, remission, and progression. The most common early symptoms include sensory abnormalities, such as tingling, numbness, itching, tightness, burning, shooting pain in the back and limbs on neck flexion (called Lhermitte's sign), difficulty walking, blurred or double vision, red-green color distortion, eye pain, and vision loss.
Initial symptoms of MS may be brief and mild. The first serious attack usually lasts weeks or months and occurs between the ages of 20-40. Symptoms of the disease vary, depending on where the damage occurs, and range from minor physical annoyances to major disabilities. Other common symptoms include: balance and equilibrium abnormalities, such as dizziness, uncoordinated movements, and tremor; bladder and bowel dysfunction, such as urgency, incontinence (inability to control urine or fecal flow), nocturia, constipation; behavioral changes, such as mood swings or depression); cognitive dysfunction, such as impaired memory, reasoning, and concentration; facial numbness; and motor abnormalities, such as muscle weakness, spasticity, spasm; sexual dysfunction, including erectile dysfunction and sexual inactivity; hearing loss; and vision abnormalities, such as eye pain, vision loss in one eye, double vision (diplopia), and involuntary eye movement (nystagmus).
Muscle weakness can involve the extremities (arms and legs) on one side of the body (called hemiparesis), both legs (called paraparesis), or all four extremities (called quadraparesis). Muscles in the affected area may tighten (called spasticity) and contract spontaneously (called spasm or myoclonus).
Many people with MS experience fatigue and need to rest and sleep during the day in order to continue their activities. The degree of fatigue may not be related to the severity of other symptoms.